subject_line
APPLICATION FOR CERTIFIED BANKRUPTCY ASSISTANT
Please complete the application in its entirety and comply with all of its instructions. If you have any questions, please email CBA Chair at cbaprogram@abja.org
I. GENERAL INFORMATION
An
*
indicates a required response.
First Name
*
Last Name
*
Mailing Address Line 1
*
Mailing Address Line 2
City
*
State/Country/Region
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Guam
Puerto Rico
US Virgin Islands
Zip Code
*
Phone Number
*
Preferred Email Address
*
II. LEGAL EMPLOYMENT
Current Employer
*
Start Date (mm/yyyy)
*
Mailing Address Line 1
*
Mailing Address Line 2
City
*
State/Country/Region
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Guam
Puerto Rico
US Virgin Islands
Zip Code
*
Title (Position)
*
Phone Number
*
Previous Employer
Start Date (mm/yyyy)
End Date (mm/yyyy)
Street Address
City
State/Country/Region
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Guam
Puerto Rico
US Virgin Islands
Zip Code
Title (Position)
Phone Number
Previous Employer
Start Date (mm/yyyy)
End Date (mm/yyyy)
Street Address
City
*
State/Country/Region
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Guam
Puerto Rico
US Virgin Islands
Zip Code
*
Title (Position)
Phone Number
III. EDUCATION/CERTIFICATIONS
College Attended
Degree
College Attended
Degree
List any certifications.
Subject/Certification Granted
State/Country/Region
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Guam
Puerto Rico
US Virgin Islands
Date of Certification (mm/yyyy)
Subject/Certification Granted
State/Country/Region
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Guam
Puerto Rico
US Virgin Islands
Date of Certification (mm/yyyy)
How long has applicant worked in the bankruptcy field?
Years
*
IV. REFERENCES
Name bankruptcy attorney(s) familiar with applicant's work. The CBA Committee reserves the right to contact the attorney/employer for verification of all information provided by the applicant.
Reference 1
First Name
Last Name
Company Name
Phone Number
Street Address
City
State/Country/Region
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Guam
Puerto Rico
US Virgin Islands
Zip Code
Reference 2
First Name
Last Name
Company Name
Phone Number
Street Address
City
State/Country/Region
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Guam
Puerto Rico
US Virgin Islands
Zip Code
VI. COVENANTS
Please open the attached pdf to review.
Written Disclosure, Use of Program Materials and Rules & Regulations
https://fs22.formsite.com/abja/images/Application_Covenants.pdf
Acceptance and Acknowledgement
*
I agree that I have read the Application Covenants document containing the Written Disclosure, Agreement Regarding use of CBA Program Materials, and Rules and Regulations
/s/ Applicant's Electronic Signature (by typing name)
Date (mm/dd/yyyy)
/s/ Supervisor's Electronic Signature (by typing name)
Date (mm/dd/yyyy)